Studies of quantitative image processing for longitudinal neuroimaging followup have been reported for more than two decades. Many algorithms and methods of brain image processing and analysis have been reported, validated and are freely available, but very few have been engineered for practical clinical and research use or integrated into clinical information systems. This has seriously limited the impact that computational algorithms and methods developed by the medical imaging research community have made on clinical neuroimaging practice and neuroimaging based clinical research. We propose to integrate available validated neuroimage analysis tools into an image informatics system AFINITI (Assisted Followup in Neuroimaging of Therapeutic Intervention), designed to enhance diagnostic accuracy and reduce error in the interpretation of neuroimaging followup studies for longitudinal followup of therapeutic intervention in several common conditions, by providing the interpreting and referring physicians with automated tools and augmented information needed for precise, reproducible, quantitative assessment of longitudinal change in brain images. The primary goal is to translate tools and techniques produced by biomedical informatics research into an actual clinical setting where it can be used in diagnosis, therapeutic decision making, treatment response monitoring, clinical education and research in neurological disease. The AFINITI system will be developed, evaluated, and implemented into the clinical workflow and validated in Brigham and Women's Hospital-Harvard Medical School (BWH-HMS) clinical neuroradiology section and the BWH-HMS Longwood MRI Research Center (LMRC). We will package the validated software into a software toolkit and distribute it in an open source environment, compatible with popular medical imaging platforms, such as VTK (Visualization Toolkit), ITK (Insight Toolkit), and 3D-Slicer.The data integration method and database schemas for this neuroimage database will also be made available to public. AFINITI system architecture and components will form a prototype for the development of future clinical imaging followup systems in other imaging centers. This will be a substantial contribution to the public health.